BONNE TERRE HEALTHCARE CLINIC, LLC (NPI# 1962043802) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962043802 |
| Entity Type | Organization |
| Organization Name | BONNE TERRE HEALTHCARE CLINIC, LLC |
| Practice Address |
11 S Division St Ste A Bonne Terre MO 63628-1701 |
| Practice Telephone | 5737231100 |
| Practice Fax Number | 5737231130 |
| Mailing Telephone | 5737231100 |
| Mailing Fax Number | 5737231130 |
| Enumeration Date | 2019-10-02 |
| Last Update Date | 2019-10-02 |
| Authorized Official Name | MARY ELIZABETH CHANDLER (OWNER PROVIDER) |
| Authorized Official Telephone | 5737476234 |
| Authorized Official Credential | FNP-C PMHNP-BC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LW0102X |
Nurse Practitioner Specialization: Women's Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LX0106X |
Nurse Practitioner Specialization: Occupational Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
11 S DIVISION ST STE A |
| City | BONNE TERRE |
| State | MO |
| Zip Code | 63628-1701 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437675477 | Kybama, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 12729 Stoney Point Rd, Bonne Terre, MO 63628 | 2017-08-22 |
| 1295092500 | Jak Properties Inc | In Home Supportive Care | 522 Benham St, Suite B, Bonne Terre, MO 63628 | 2012-04-12 |
| 1013121599 | Joseph Richard Engel | Dentist | 20 W Johnson St, Bonne Terre, MO 63628 | 2007-05-10 |
| 1215093844 | Debra Long Morgan | Dentist | 20 West Johnson Street, Bonne Terre, MO 63628 | 2006-12-28 |
| 1497811459 | Robert Oliver Greenwald | Dentist | #20 W Johnson, Bonne Terre, MO 63628 | 2006-12-27 |
| 1255964508 | American Nursing & Rehab LLC | Assisted Living Facility | 10 Lake Drive, Bonne Terre, MO 63628 | 2020-02-14 |
| 1962679746 | Robert O Greenwald Dds PC | Dentist | #20 W Johnson, Bonne Terre, MO 63628 | 2008-05-12 |
| 1427045004 | Pairat Vibulakaopun | Internal Medicine | 527 Benham St, Bonne Terre, MO 63628-1205 | 2005-09-29 |
| 1124014030 | Kenny Ratana | Radiology | 527 Benham St # B, Bonne Terre, MO 63628-1205 | 2005-09-26 |
| 1669017315 | Patricia Ann Peterson | Nurse Practitioner | 527 Benham St, Bonne Terre, MO 63628-1205 | 2019-11-15 |
| Find all providers in zip 63628 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336604370 | Melody Kay Willis | Nurse Practitioner | 1857 Rue Lamande, Bonne Terre, MO 63628-9206 | 2019-02-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316545254 | Brenda S Halton | Nurse Practitioner | 1010 West Columbia Street, Farmington, MO 63640 | 2020-10-13 |
| 1376152546 | Chijioke Francisca Mbah | Nurse Practitioner | 900 Sw 33rd St, Lees Summit, MO 64082-4191 | 2020-07-23 |
| 1740807825 | Aldijana Sacic | Nurse Practitioner | 8525 Glenwood Dr, Saint Louis, MO 63126-1849 | 2020-07-06 |
| 1639796766 | Courtney Paige Schult | Nurse Practitioner | 431 Stonewater Dr, Pevely, MO 63070-3210 | 2020-07-06 |
| 1912524059 | Farah Lynn Shaddix | Nurse Practitioner | 1103 Warm Winds Dr, O Fallon, MO 63366-6327 | 2020-07-05 |
| 1669097119 | Melanie Nicole Beckham | Nurse Practitioner | 1100 South Springfield Ave, Suite B, Bolivar, MO 65613 | 2020-06-10 |
| 1215551973 | Nicole Lynn Parker | Nurse Practitioner | 1000 Jackson St Apt 1, Saint Charles, MO 63301-2676 | 2020-05-28 |
| 1386273217 | Andrea Morrow Wright | Nurse Practitioner | 8833 N Congress Ave Apt 813, Kansas City, MO 64153-1991 | 2020-04-03 |
| 1700413580 | Solange-belle Boma | Nurse Practitioner | 6326 Ne 44th St, Kansas City, MO 64117-1687 | 2020-03-24 |
| 1063044626 | Beatriz Fortaleza | Nurse Practitioner | 2305 South 65 Highway, Bldg A., Marshall, MO 65340-3702 | 2020-02-11 |
| Find all providers with the same taxonomy | ||||
| City | BONNE TERRE |
| Zip Code | 63628 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.